Post by peterd on Aug 26, 2013 17:46:19 GMT -8
> Effective October 1, 2013, Tricare will only reimburse VA 20% of the allowable charge versus the past practice of paying 80% for non-service connected care received in the VA for Tricare for Life (TFL) beneficiaries rated at less than 50% disabled. While this is not a new law, it has not been enforced.
> > The rationale that supports this change follows:
> >
> > Although VA Facilities are Tricare-authorized, they are not Medicare-certified.
> > Medicare, by statute, cannot reimburse for care provided by a Government facility.
> > Simply put, the VA can’t bill Medicare and Medicare can’t reimburse the VA for care.
> > Since the VA can’t be Medicare-certified, it presents as an opt-out Medicare provider.
> > Therefore, Tricare reimburses the VA what it would have paid if Medicare had been primary – which is 20% leaving you with a bill for the remaining 80%.
> >
> NOTE: Here is the key info: The solution: For Military Retirees with less than 50% VA rated (medical care), use your TFL benefit in the community for non-service connected TFL care to prevent being billed for 80% of the allowable charge.
>
> > The Tricare News Release of August 14, 2013 states:
> > - See more at: www.moaablogs.org/healthcare/2013/08/beware-non-service-connected-vatfl-healthcare-users/#sthash.gm0d9ouR.dpuf
> >
> > The rationale that supports this change follows:
> >
> > Although VA Facilities are Tricare-authorized, they are not Medicare-certified.
> > Medicare, by statute, cannot reimburse for care provided by a Government facility.
> > Simply put, the VA can’t bill Medicare and Medicare can’t reimburse the VA for care.
> > Since the VA can’t be Medicare-certified, it presents as an opt-out Medicare provider.
> > Therefore, Tricare reimburses the VA what it would have paid if Medicare had been primary – which is 20% leaving you with a bill for the remaining 80%.
> >
> NOTE: Here is the key info: The solution: For Military Retirees with less than 50% VA rated (medical care), use your TFL benefit in the community for non-service connected TFL care to prevent being billed for 80% of the allowable charge.
>
> > The Tricare News Release of August 14, 2013 states:
> > - See more at: www.moaablogs.org/healthcare/2013/08/beware-non-service-connected-vatfl-healthcare-users/#sthash.gm0d9ouR.dpuf
> >